Provider Demographics
NPI:1811102809
Name:ATIENZA, ANNABELLE LAGASCA (DDM)
Entity type:Individual
Prefix:DR
First Name:ANNABELLE
Middle Name:LAGASCA
Last Name:ATIENZA
Suffix:
Gender:F
Credentials:DDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 W MARCH LN STE 100A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6468
Mailing Address - Country:US
Mailing Address - Phone:209-594-1119
Mailing Address - Fax:209-594-1740
Practice Address - Street 1:2431 W MARCH LN STE 100A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6468
Practice Address - Country:US
Practice Address - Phone:209-594-1119
Practice Address - Fax:209-594-1740
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD41584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist